GW1--07705_Well Construction - GW1_20231122

WELL:CONSTRUCf ION RECORD
For formal Usc ONLY:.
'Phis f;+nn can.be used for.singie or multiple welts'. 1
Il.Welt Cpturtcta Inforulation: '
`14,,WATERZONfS - . .
Robert Miller FROM TO D1SCRIPTION '
Wok Cor lmetbr N;imo ft: ft.. I
r.
2675A :A. ft: I i
NC WeD Con ctorCcnifreMionNumber • 'LS::OUTEei CASING'(roi"iimutli=¢ayeinicllsl'ORLiNER'ttfap'Crcabtc)•
i FROM -'I TO- - `DIAMETER' ' THICKNESS MATERIAL
SAEDACCO 0 .f4 6 . it, 2 �' in. SCH-40 PVC
Gonlp;utyNome, • 'I6:'INNER.CA•SiNG OR TU8INC .eaiherinat duffed-too'
-FRONT TO • DIA1tETCR THICKNESS' MATERIAL
2:Wdt Conitrlrctio.n Pt rout#; . it. ft. 'pL
Litt Ofniyi/kMbrewzUpeamits,(i_c.County;'Stn:r,Voriarrre,1iy"fi[0'ts}etr..) '
'14 . ft, irr
3.'Wcll.[3sc(checl RdI usc)t • 17:5t;tt N . J . - - •
• Water Supitly Well: •. FOON1• . .TO DLtMETF.rt SL OT867-K THICKNESS• NIATRRiAI,
DAgiicultuml CililtinicipaliPltblic. 6 ft..,- ].6 Rc 2 - - 010 sox-4o PVC
-
Mea'tlwnnal(Heating/Cooling Supply') CiResidentiat.NaterSuppb(single) 11' .r�• in,
®hrdustrial/Conmicrcial ®Residential Water:Supply(slcamd)' :itt 0GRour ...,
PnA1 TO. • MATERIAL EMPLACEAISVT51611100bAllOUNT
IDIrrlpntion• • 0 ft. 3 ft., Portland Pour
] pu 1VtttcrSutlplyWelk. •
ft,. ft,
• tdMoaitoring DRcco.«ty ' -
Injection Well: R. fft. . . •
CDAgtlifcrRceliarge laoroundnalcr'ltentediatiou • •t9LSANDIGILWEL,l''ACK'(11aiuplleabtily:,'- =' - --.- .,. : '
--MOM TO' MATERIAL -I sIPI.ACF:HEVTHrTtIOI
17Anttifcr.Storagc and Rccocety ElSalinity Hamer 4 R. 16 ft. sand' #2
0 Aquifer Tcst CJSlonn%•atcepra nage •ft... ft•.
C71=1ipetinlcnlal Tixhnolo ASnbsictcncc: otdrrit a.DRIL LING'LOG'(aftaeti`addllionul Sleets',ifnccecsarvl
• dGeodsennal(ClosedLeap) IJTrrcer FROM' TO' ' DESCRIPTION(0abhhs ilet.ai4' aktli,e.min AT.Ht.) '
CGwtltennal(FleatinglCaoling Return) - DOther(e_tplail mider,#21-Retuaiks) 0 ,ft. 4 ft, •Silt;sand
. 4 ' fr., 16 fL Sand'
4I:Date Well(s)Coniplcted:'10-31-23 `Welt 11)#RI-MWll ;'
y.
5:t:Weill Cneatlan: :ft. ft,
NOV 2 2liL(/}yq1
Greenville Utilities Commission ,ft. ft, J
Facftityl.Ow•ncrNamc ' Faeilit)•II)iOfappl'ldable). — R. ft , ..i:;i.-.''^`,:.^n.P,-.-. ..c?; rr i':-.S
801 Mumford Rd., Greenville, NC, 27834, i4 ft, • i • t'"''"'=''-"•'
Plgisicid Addmss,City.and Zip '.21.REMARKS' . ,
' - Pitt -1 foot bentonite seal from-3 to 4'
County • Pane]hi ililcadonNo:(PiN) ' .
.5h,LinitudeUnd"1Ainginrileinde ccsltliinutcsJscerindsiii dceimaldcfitces:
.2t Certification::
(itu ell 11 itt,one laillong is's cIllekra) '
35.'632028 N 77.363108 • FVI` '- 11/8/2023
.Sigmu reel..-c::.x.•tir.,. �C';!•NC%�-.-- Date
6. (:ttl')the s a'lI(S); 1Pt.r111Hltettt or flTdntpOtilt3 di r ifr a arm.'hrreh Terri v lhar tau,irdlN wux tine CZ,r i,ucred wpm tori1R,i c
s x f r f ( 1
with 15A NC.tc 02C;0100 or 1 frt hrCttC'(rC;moo Well Coxarrnctfar Srarulirrtls acid shay a
Ift.t
his ht a acpair to ati.eziatin„Mill: OYt -r or ®ND airrofrh r f ir�eto hrii hear prat ultd ry the writ(i crier,
if rh(s1f'a ripalr fill onr krroir yell coruuacriari hrfpmrttrlorr and raplaln the nature oldie
repair rethlor 021.'rernarkistwrilin or on rhn balk of rhiv form. - 23:5rte diagram or additional.Well details:
You ma}•use the back of this page to ptoc'ide idiliUonal,.cell site details or Welt •
IL Nntuberof Welts constructed: 1 - 'constriction details,.You inay Also attach additional pages if occessasy.
For rinilrlple Rdecrlonitrion-miner simply mells,ONLY trial rhe.sarrrecorrstruction,you cam
aahmfrainc/ym"r. St1BMRTTAl,iNS,TUCTLONS
9.Total well dcpt4 below land surface. 16 .' (ft-) Slat. Far Att Wells Sabath!Ius'forum within 30.days of completion Of welt
For hralripfcicellslisr all dfrrhiifdeererir(C.Twrrfpre-1@?00'ani1.2@i0O) 'construction to the following: I•
10.Static water W'el below toll of casing: - (it,) Dlvlsion of tauter iIO HRrceti,•Infrlrnilltiuu Processing Unit,
1/watt r&i'er is drove airing.au••+ 1617 Afail.Ser6•ice Center,ILrlcig1i NC-27699-16t7
11.'Borehole diameter:8.25" (in.) 246.Ong Itifcetian_ Vetgs ONLY: iln-addition to-sending:ilte fame to theiddress in
244 aliov'e; also submit a copy'Of-this hunt within 30 days-of.completion of Well 12.Weil'construction method:HSA construction Cathie fbllotvhlgr: I '
(1.c.3iigrr;rdary,crtlrl 'direct posts etc:} Dlvisiait of Water Resources,Underground Injection Centrol.Program,
FOR WATER SUPPLY WELTS ONLY: - 1636 plait Sen.lce ICentcr,Raleigh,NC 27699-1636
13;a SFicld(Om)• ,1Tetiloil of test: 24e-.For%Water Supply&[sleet(Ion!Welty:
Also submit one'copy of this:form Within 36,days of complelioti of
1311:Disinfection type: Amount: well-coilitniction to the county with deparinient•of the county where
. constructed.
-RumG1v-1 NonhCaroltna Department ofPi itOMMin anti Natural Resources,WWII lo a ok Water Ellpuro4 Revised Argutt2013
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